By the time the doctors reached her, the babies were already coming. Right there on the doorstep of Al-Amal hospital in the North of Syria, the last open door for many miles, Batoul delivered twins. It happens two or three times a month now: women running from hospital to hospital, finding only locked entries, dark hallways, or facilities that are filled to the brim with no staff or equipment. The Al-Amal hospital in Azaz funded by CARE is the place they come to because there is nowhere else. The city and its surroundings hold roughly 350,000 people. Since the regime fall, many families have returned home hoping for stability, but they continue to come here for treatment. They come because this hospital is the only one still functioning across vast stretches of Northwest Syria. Some travel for hours. One woman came 150 kilometers just to deliver her child. CARE’s local partner Violet runs it. Together, CARE and Violet are keeping the last anchor from being pulled under, for now.
No option of closing
Across the region around Azaz, 40 hospitals and 50 medical facilities have shut down in the last year. In Syria as a whole there are already 366 health facilities suspended or operating at reduced capacity. The funding gaps are enormous. CARE has only a few months of financial support left for Al-Amal. After that, this hospital too may fall silent. Inside, the waiting rooms stay full. Every chair holds a mother or a child. Every corridor echoes with the same question: how much longer will this place stay open? “In April, when the funding was reduced, there was a rumor in the community, that the hospital will have to close. Panic spread immediately and people started to campaign for us to continue. This just breaks my heart,” says gynecologist Dr. Ghena Alqotini. Since April, the project had to be reduced to minimum standards. Staff was reduced significantly. But the number of patients did not shrink. It grew. There is nowhere else for them to go.
Dr. Ghena works two days a week for a 48-hour shift. She lives across the border in Türkiye during the week, caring for her children. Her weekends are spent here, delivering the children of others. Her white coat and headscarf frame her violet tunic, matching the hospital’s emblem and her lipstick. She smiles at mothers whenever she can, but she is exhausted. Since last year, her workload has risen by at least 20%. “There are no longer breaks. I work for 48 hours straight. There are too many cases, and we have too few midwives since April.” Still, she keeps coming. “I am proud of the work I do here, and I feel a lot of joy when I see the mothers that I helped. I am Syrian, that is why I am working here to help Syrians.” But she carries fear as well. “Our work here is humanitarian. We need to take care of every case and do the best we can with the limited resources we have. Once the funding stops, we do not know what we shall do. There is no option of closing the hospital, there would be so many deaths.”
Babies being born on the streets
All around her, the health system is collapsing. So, the mothers run. “They run from hospital to hospital, standing in front of closed doors or are rejected, until they hopefully find our hospital here, but it’s often too late and they deliver on our doorstep,” says Dr. Ghena. Delivering at home or outside brings high risks: heavy bleeding, injuries, infections, and tetanus for those never vaccinated. Al-Amal’s staff covers the ground with whatever they have and helps mothers where they stand, then carries them inside. “It makes me very emotional to see the distress of these mothers. And it motivates me to continue doing my job, no matter how hard it is now. These mothers are traumatized and seeing them smile again after we helped them, is enough for me to continue every day,” Dr. Ghena adds. But fear now walks ahead of the women. “A lot of these mothers are so scared. They are afraid that once they come here, we will also turn them away as everyone else. They are very surprised that we never say no to anyone, as long as we still can.”
One month ago, 18-year-old Batoul arrived after hours of looking for help. She and her mother-in-law Zahra, 55, live in a camp for the displaced, with nothing left of their old life and no means to afford costly health care. “At 6 a.m. I could feel the babies coming and we rushed to two different hospitals. The first denied us as they did not have any incubators left for the twins. The second did not have any more doctors working there. We were desperate and looking for help. The babies were coming. At 9 a.m. we finally found this hospital, and they took us in. At 9:15 the twins were already born.” She remembers the fear most. “It was so stressful, and I was so afraid for my life and that of my babies. I was bleeding so much.” Twin grandma Zahra’s voice shakes when she adds: “The babies would have died without the help of this hospital.” The head midwife adds: “The babies were a little blue due to the lack of oxygen, and we had to administer first aid, and the twins were transferred to the incubator immediately. They weighed less than 1kg and their lungs were not fully grown yet.” The twins spent 20 days in the incubators. But they live. And they are healthy. They are sleeping on their mother’s lap. Still very small and fragile. Ahmed wears a white shirt with puppies and the words “You are my sunshine,” and Mustafa wears a yellow hat with a chick breaking out of an egg. They survived because one hospital door was still open.
Al-Amal averages 300 deliveries every month. No mother pays for care. Most who come here live in camps, in tents that freeze in winter. Many are low-income mothers, already facing a mortality rate 1.8 times higher than the global average. Maternal mortality in the region is rising sharply with – according to the World Health Organization (WHO)– 60 deaths per 100,000 live births. Previous years the number were between 20 to 30. With more closures, more funding cuts and a continued lack of attention for Syria, this number will rise again. “There will be a health catastrophe coming, if we do not continue the support for the people here. We need to raise awareness for what is happening. A lot can still be avoided, but we need to act now, because every life, every mother and every child matter,” says Dr. Ghena.
